radiology

For ALL radiology services provided and billed through HNS, the medical necessity for the services must be clearly documented in the patient's health care record, must be properly reported using the most appropriate CPT code and must be consistent with the patient's chief complaint, clinical findings, diagnoses and treatment plan.

All radiology services provided and billed through HNS must be consistent with all HNS and HNS contracted payor policies, the policies of applicable state licensing boards as well as state and federal laws.

A.  HNS Providers must document all radiology studies performed and/or interpreted in the office. 

B.  The area(s) initially x-rayed must be medically necessary and consistent with the patient’s initial chief complaint.

C.  Subsequent x-rays must be medically necessary, and consistent with the patient’s complaint, clinical findings, diagnoses and treatment plan.

D.  A written radiology report to document the provider’s interpretation of the radiograph(s) must be maintained in the patient’s health record. These reports must be signed or initialed by the provider and should include:

1.  Patient identifying information (patient name, DOB, etc.)

2.  Date of study as well as an accurate description of the radiological findings

3.  Impressions

4.  Recommendations for follow-up studies that may be needed to reach a final diagnostic impression

E.  The specific area(s) x-rayed must be documented

F.  The date of the study must be documented

G.  The name of the person performing the x-ray study must be documented

H.  There should be documented, supporting evidence that clinical findings support the need for repeat x-rays

I.  Routine repetitive x-rays within a 90 day period require the following documentation:

1.  Evidence of a new injury reported for the same area as the initially reported area

2.  An initially identified pathology or biomechanical aberration requiring further investigation

3.  A new symptom in the same area appears which was not present initially

To demonstrate a subluxation by x-ray, the x-ray must have been taken at a time reasonably proximate to the initiation of treatment.

An x-ray is considered reasonably proximate if it was taken:

1.  No more than 12 months prior to the initiation of a course of treatment or;

2.  No more than 3 months following the initiation of a course of treatment.

Radiographs are generally considered medically necessary only for the purposes of diagnosing specific problem area(s) documented as a chief complaint with supporting objective clinical findings verifying their necessity.

Repeat x-rays must be clinically indicated and the reason(s) clearly documented in the clinical record.

For billing purposes, an x-ray “view” is a separate exposure to radiation. Therefore, full spine x-rays cut into sections do not constitute multiple views, unless multiple exposures are taken.

Single view x-rays without opposing views are not considered of diagnostic quality. An occasional “spot shot,” or single view, may be performed as a follow-up to review a specific area in question.